In a groundbreaking multi-country observational study recently published in Eurosurveillance, researchers have unveiled the substantial societal economic burden posed by respiratory syncytial virus (RSV) infections in young children treated primarily in outpatient settings across Europe. This detailed investigation spans Belgium, Italy, the Netherlands, Spain, and the United Kingdom and offers pivotal insights that could reshape public health policies and the strategic deployment of RSV immunisation initiatives within the coming years.
RSV is a ubiquitous respiratory pathogen, infecting nearly every child by the age of two, and is the foremost cause of acute lower respiratory tract infections in infants and young children worldwide. While the severe cases of RSV often necessitate hospitalisation, the vast majority of RSV infections manifest as milder illness, managed effectively in primary care environments. Despite their ostensibly modest clinical presentations, these infections exact a significant underappreciated toll, particularly in non-hospital settings, through repeated primary care visits and the resultant indirect costs, notably parental work absences.
The observational cohort assembled for this study encompassed 3,414 children under the age of five presenting with acute respiratory infections during sequential RSV seasons—2020/21 (exclusively UK), 2021/22, and 2022/23. Comprehensive RSV testing was conducted, revealing that approximately one-third (33%) of these children were infected with RSV. Parents provided detailed data through structured questionnaires regarding healthcare utilisation and work absences attributable to their child’s RSV illness over the subsequent 30-day period.
Analyses underscore a striking heterogeneity in the economic impact across the participating countries. Primary care treatment costs per RSV episode ranged markedly, from as low as 97 euros in the Netherlands to as high as 300 euros in Spain. Contrastingly, the economic consequences of parental absenteeism from work—another dominant cost driver—displayed an even wider disparity, fluctuating between 454 euros in the UK and 994 euros in Belgium. This variance underscores systemic differences in healthcare delivery models, parental leave policies, and sociocultural factors influencing care-seeking behavior and work patterns.
Decomposing the cost structure further reveals that repeated visits to primary care physicians comprised the bulk of healthcare expenses, eclipsing costs related to specialist consultation and pharmaceutical prescriptions. Although medication is a direct clinical intervention for RSV illnesses, its role in incurring expenses proved minimal, constituting the smallest fraction of the overall economic burden across all assessed age groups and nations. This finding challenges assumptions that drug costs predominate and shifts the focus towards optimizing outpatient care pathways.
Age stratification of the data yields nuanced insights into cost distribution dynamics. Infants younger than one year incurred higher healthcare costs, primarily attributable to intensified clinical monitoring and care-seeking behavior prompted by increased vulnerability. In contrast, parental work absences accounted for a greater proportion of the economic burden among children aged one to five years, suggesting that older children’s milder symptoms perhaps require less intensive clinical intervention but still disrupt family routines significantly.
One of the study’s most compelling results pertains to the average number of primary care visits per RSV episode, varying from just 1.4 in the Netherlands to a substantial 3.0 in Spain. Parallel to this, hospitalisation rates ranged widely—from a relatively low 4% in the Netherlands and Italy to a striking 44% in Belgium. Researchers caution that these figures may reflect methodological differences, as the Belgian cohort included children presenting to out-of-hours care, potentially skewing hospitalisation rates upwards.
Medication prescription rates also demonstrated wide international variation, fluctuating between 26% in the UK and as high as 77% in Italy, reflecting disparities not only in clinical guidelines and practice but also possibly in parental expectations and healthcare access. Similarly, parental absenteeism from work, a critical indirect cost metric, differed profoundly: while only 13% of parents in Spain reported missing work, with a mean absence of just 1.3 days, nearly three-quarters of Belgian parents (71%) reported work absences averaging 4.1 days.
However, the researchers acknowledge several limitations in the study’s design and data interpretation. Potential selection bias may have influenced physician recruitment choices, potentially affecting representativeness. The time scope of cost assessment was limited to 30 days post-initial consultation, a pragmatic but narrow window that may underrepresent longer-term economic impacts. Moreover, the influence of the ongoing COVID-19 pandemic on healthcare-seeking behavior and reporting patterns cannot be wholly discounted.
In analyzing parental work absences, although self-reported data proved a pragmatic alternative when formal documentation was unavailable, some assumptions had to be made to impute missing values, inevitably introducing uncertainty. Additionally, while the study attributed all recorded costs to RSV, it is possible that co-infections with other viruses concurrently influenced clinical severity and economic outcomes, a confounder that the observational design could not fully disentangle.
The study’s findings carry profound implications for the design and prioritisation of RSV immunisation strategies, particularly in acknowledging the substantial economic burden borne outside of hospital settings. Most prior economic evaluations of RSV have selectively concentrated on hospitalisation-related costs, inadvertently underestimating the virus’s full societal impact. By integrating outpatient and parental productivity loss metrics, this work provides a more holistic economic appraisal crucial for informing cost-effectiveness analyses of emerging vaccines and monoclonal antibody programs.
This research highlights the necessity of tailoring vaccination policies to individual country contexts, given the marked variability in cost structures driven by healthcare system design, cultural norms, and social policies. Such variability suggests that a one-size-fits-all approach to RSV immunisation may not optimise health outcomes or economic efficiency across Europe.
Importantly, the timing of this research is highly relevant as the advent of new RSV vaccines and immunisation strategies for infants and older children transitions from clinical trials into real-world implementation. As these interventions gain regulatory approval and policymaker attention, the data presented provide a critical evidence base to guide decisions balancing clinical benefits with economic sustainability.
In the broader context of pediatric infectious disease management, this work elevates understanding of how common respiratory pathogens, even when managed predominantly outside hospital settings, can exert a substantial cumulative economic toll. The research encourages further studies to explore long-term sequelae, indirect costs beyond parental work absence, and the interaction of RSV with other respiratory viruses in pediatric populations.
Ultimately, mitigation of RSV’s impact will require a multipronged approach, encompassing enhanced surveillance, vaccination, and supportive healthcare infrastructure, underscored by refined economic evaluations such as those presented here. This study starkly illuminates the hidden societal costs of RSV primary care infections and provides a compelling rationale for targeted investment in preventive strategies that could alleviate both clinical and economic burdens in the near future.
Subject of Research: People
Article Title: Economic impact of RSV infections in young children attending primary care: a prospective cohort study in five European countries, 2021 to 2023
News Publication Date: 22-May-2025
Web References: 10.2807/1560-7917.ES.2025.30.20.2400797
References: Eurosurveillance, 2025
Keywords: Respiratory syncytial virus, RSV, economic burden, primary care, pediatric infections, parental work absence, Europe, healthcare costs, immunisation strategies
Tags: acute respiratory infections in childreneconomic burden of RSVhealthcare costs associated with RSVimmunisation initiatives for RSVmulti-country RSV researchoutpatient treatment for RSVparental work absences due to RSVprimary care systems impactpublic health policies for RSVrespiratory syncytial virus studyRSV infection statistics in EuropeRSV infections in children
